Abstract
Although retroviral therapy (ART) has changed the HIV infection from a fatal event to a chronic disease, treated HIV patients demonstrate high prevalence of HIV associated comorbidities including cardio/cerebrovascular diseases. The incidence of stroke in HIV infected subjects is three times higher than that of uninfected controls. Several clinical and postmortem studies have documented the higher incidence of ischemic stroke in HIV infected patients. The etiology of stroke in HIV infected patients remains unknown; however, several factors such as coagulopathies, opportunistic infections, vascular abnormalities, atherosclerosis and diabetes can contribute to the pathogenesis of stroke. In addition, chronic administration of ART contributes to the increased risk of stroke in HIV infected patients. Concurrently, experimental studies in murine model of ischemic stroke demonstrated that HIV infection worsens stroke outcome, increases blood brain barrier permeability and increases neuroinflammation. Additionally, residual HIV viral proteins, such as Trans-Activator of Transcription, glycoprotein 120 and Negative regulatory factor, contribute to the pathogenesis. This review presents comprehensive information detailing the risk factors contributing to ischemic stroke in HIV infected patients. It also outlines experimental evidence demonstrating the impact of HIV infection on stroke outcomes, in addition to possible novel therapeutic approaches to improve these outcomes.
Highlights
Human immunodeficiency virus (HIV) infection causes a progressive depletion of the immune system, leading to acquired immunodeficiency syndrome (AIDS)
While there is no cure for HIV infection, antiretroviral therapy (ART) has changed this from a fatal disease to a chronic, and manageable condition for people living with HIV (PLWH) [1,2]
Candida albicans and cytomegalovirus infections have been associated with HIV infection and stroke in a few case reports, further investigation is required to confirm their roles in the pathogenesis of ischemic stroke in HIV cases [54,55]
Summary
Human immunodeficiency virus (HIV) infection causes a progressive depletion of the immune system, leading to acquired immunodeficiency syndrome (AIDS). The number of stroke incidents were noted to be higher in HIV-infected children and young adults, without traditional risk factors [23,24]. A pre-ART population-based study by Cole and coworkers documented that the incidence of ischemic stroke was nine times higher in AIDS patients than in control individuals [28]]. In the post-ART era, several studies demonstrated an increased risk of stroke in PLWH independent of age and traditional vascular risk factors [31,32,33]. Several population-based studies suggested that young individuals with HIV infection have an increased risk of stroke compared to non-HIV individuals, suggesting the role of HIV infection as a cerebrovascular risk factor [17,37,38]. We will review available data on the association between HIV infection and risk of stroke, based on published clinical and postmortem studies, the possible mechanisms of stroke occurrence in HIV-infected patients, and the approaches to improve stroke outcomes in HIV infected patients
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